One beautiful day in September, Lisa Anderson-Shaw sat in a windowless, cramped room at University of Illinois Medical Center at Chicago with the family of a very ill elderly woman.

The woman, who had severe heart disease, couldn't be operated on. Her physicians recommended that the family keep her comfortable and let the inevitable—death—happen. As director of the clinical ethics consult service at the hospital, Ms. Anderson-Shaw helped the family sort through options.

The short meeting was contentious. The woman's husband accused the hospital of “giving up” on the patient. The daughter said her mother was full of life and wanted to see her great-grandchildren grow up. Both threatened to move the patient to another hospital.

In the end, the family insisted on treating the patient with dialysis—and has commenced the life-prolonging, yet painful and expensive procedure.

“I probably didn't make a difference,” Ms. Anderson-Shaw says, reflecting on the meeting, “and I always leave thinking, ‘Did I make it worse?' “

END-OF-LIFE DECISIONS

Technology that can extend biological life almost indefinitely spawned the field of medical ethics. Now it's up to ethicists like Ms. Anderson-Shaw to answer the question: Just because technology can prolong a life, should it?

It's a question Ms. Anderson-Shaw faces a dozen or so times a month, as she performs the often-thankless service of helping families through excruciating end-of-life decisions. Her cases range from sensational—the conjoined twins who were born at University of Illinois Medical Center last year and died in August, having spent their entire lives in intensive care—to the more common, such as the family with the elderly, dying mother.

“No two cases are alike,” says Ms. Anderson-Shaw, 49, whose black T-shirt, low-slung black jeans and riding boots suggest anything but an ethics expert. Small and blond, she is a former champion baton twirler who is the twirl team coach at her children's high school and calls exhausting spin classes her favorite form of exercise.

She draws on extensive training as a registered nurse and nurse practitioner, a doctorate in public health and a master's in medical ethics, plus years of experience, to guide others through critical health care decisions.

“She is marvelous—she is enthusiastic and combines it with a good pragmatism,” says her boss, William Chamberlin, chief medical officer at the University of Illinois Medical and Health Sciences Center, noting that she is the first non-M.D. to chair the institution's ethics committee.

A deep well of emotional intelligence helps: “You need to know yourself. . . . You need to have substantial empathy for the people involved,” Dr. Chamberlin says.

“She's a phenom,” says Mark Siegler, director of the MacLean Center for Clinical Medical Ethics at the University of Chicago. “We have 10 people who work together to do what Lisa does as one person.”

Ethicists don't make decisions for families; rather, they explain options and walk them through the decision-making process. To do so, they pose four questions: What does the patient want? What is the likely prognosis? What social, religious or contextual factors come into play? And finally, what is the prospect for the patient's quality of life? Experience helps Ms. Anderson-Shaw keep her opinion out of the mix: “I just don't talk about what I would do in that situation.”

BEYOND MONEY

Money is not an issue: A monetary value cannot ethically be placed on life, and Ms. Anderson-Shaw will not raise the question unless a patient's family does. But, she says, the subject of what health care costs does raise conflict, especially at a state hospital, where many patients don't have insurance.

The conflict arises in “futility” cases, when families ask for aggressive treatment that doesn't prevent death but just postpones it. “The conflict is, how can we best use our resources?” Ms. Anderson-Shaw says. “We have to use what we have to help the most people.”

Rather than wins and losses, she thinks of case outcomes as “good” or “not so good.”

One good outcome: Several years ago, a child of Jehovah's Witnesses was brought to the emergency room suffering from severe anemia. Doctors wanted to perform a blood transfusion, which is against the religion's teachings.

Ms. Anderson-Shaw worked with the parents' adviser, an elder in the church, to arrive at a suitable form of treatment, says Mary Lou Schmidt, head of the hospital's pediatric hematology and oncology division.

After the case, the church elder remarked, “in most hospitals, this would not have happened,” Dr. Schmidt recalls. “The hospital would have gotten guardianship and done the transfusion.'”

One not-so-good outcome: The conjoined twins, whose $5.6- million medical bill made headlines. Ms. Anderson-Shaw, who was not asked to consult until after the twins were born, expressed concern not so much for the twins' mother, who had insisted on aggressive life-support measures, but for the twins' caregivers.

Round-the-clock care for infants who are almost certain to die “becomes a matter of moral distress for the providers,” who feel that “they're contributing to suffering,” she says.

SYMPATHETIC

Growing up in the tiny Downstate town of Petersburg, Ms. Anderson-Shaw was heavily involved in church groups. As an adult, she attends church most Sundays at Christian Church of Clarendon Hills.

Despite her faith, it's vexing to her when families summon “God's will” to help loved ones through a medical crisis. “I want to say, ‘Let's disconnect all the machines and then see God's will,' “ she says. “It's difficult to respond to those beliefs.”

She herself has never experienced a family medical crisis or any other life-altering event. Her parents are still alive and healthy, as are her five children, ages 12 to 20. Yet Ms. Anderson-Shaw is sympathetic, and has been her entire life.

“She always had that ability to just listen—people shared what was on their mind and she would give them counseling,” says her brother, Allen Anderson, 50.

Her interest in ethics was piqued during a philosophy class at Southern Illinois University, where she earned her undergraduate nursing degree. Her experiences in the mid-1980s as a young nurse treating AIDS patients at the University of Indiana Hospital in Indianapolis deepened that interest. She was surprised when some nurses spoke disparagingly of a patient with HIV-related pneumonia.

“I started to think about ethical issues—can you refuse to take care of someone?” she says.

In 1987, Ms. Anderson-Shaw and her husband (the two are divorcing) moved to Chicago. She enrolled in a medical ethics master's degree program at Loyola University Chicago and received her degree in 1991 while working full time as a nurse practitioner at the University of Illinois at Chicago Hospital.

She joined the hospital's ethics committee in 1989; in 1998, she became its co-chair. In addition to consulting at UIC hospital and contracting her services to MacNeal Hospital in Berwyn and RML Specialty Hospital in Hinsdale and Chicago, she teaches ethics classes at UIC hospital and Loyola University Chicago.

Not every hospital has an ethicist; small hospitals dotting rural Illinois certainly don't. In 2003, Ms. Anderson-Shaw established the Illinois Healthcare Ethics Committee Forum, a website where rural hospitals can seek advice on ethical issues. In 2004, she inaugurated biannual ethics conferences, one in Springfield and another at Loyola University Medical School in Maywood.

She is compulsive about note-taking, organizing and record- keeping, and is naturally energetic. She says she's never moody, despite the emotional demands of her job.

Ms. Davila and her family wanted do-not-resuscitate and do-not-intubate orders for him, and some of his doctors disagreed. “They made us feel we were trying to cast him aside because he was too much trouble,” says Ms. Davila, a registered nurse who lives in Springdale, Ark.

Ms. Anderson-Shaw was an “impartial third party, a good balance” to bring the sides to resolution, says Ms. Davila, 57. “She gave us a lot of comfort and support and helped the other medical professionals listen to us.” The family prevailed, and Ms. Davila's brother survived. He is now recovering at his Chicago-area home.

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Rather than wins and losses, Ms. Anderson-Shaw thinks of case outcomes as 'good ' or 'not so good.'